Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.07 High blood pressure

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Why is it important?:

High blood pressure, also referred to as hypertension, is a major risk factor for stroke, coronary heart disease, heart failure, kidney disease, deteriorating vision and peripheral vascular disease leading to leg ulcers and gangrene.

The National Heart Foundation of Australia defines high blood pressure as a systolic blood pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg and/or patient receiving medication for high blood pressure (NHF 2010). Major risk factors for high blood pressure include increasing age, poor diet (particularly high salt intake), obesity, excessive alcohol consumption, and insufficient physical activity (AIHW 2011c). A number of these risk factors are more prevalent among Aboriginal and Torres Strait Islander peoples (see measures 2.16, 2.18, 2.19 and 2.22).

High blood pressure is more common among Aboriginal and Torres Strait Islander peoples than non-Indigenous people and is a major contributor to the increased risk of heart attack, stroke and other circulatory diseases (AIHW 2002a). One study of Indigenous Australians living in urban WA found that, after controlling for other cardiovascular risk factors, those with high blood pressure were twice as likely to die or be hospitalised due to a cardiovascular event (Bradshaw et al. 2009). It is estimated that high blood pressure is responsible for 6% of the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians (Vos et al. 2009; Vos et al. 2007).

While for some people, the propensity to develop high blood pressure appears to be inherited, it can often be prevented or controlled by leading an active and healthy life, remaining fit, avoiding obesity and diabetes and, if necessary, taking regular medication (Passey et al. 2010). For those with high blood pressure, treatment with long-term medication can reduce the risk of developing complications, although, not necessarily to the levels of unaffected people (AIHW 2011c). Reducing the prevalence of high blood pressure is one of the most important means of reducing serious circulatory diseases, which are the leading cause of death among Aboriginal and Torres Strait Islander peoples (see measure 1.23).Top of page

Findings:

No national data are currently available for the prevalence of high blood pressure in Australia. The 2012–13 Australian Health Survey will include measurement of blood pressure. For this report, three national data sources provide an indirect measure of the relative prevalence of high blood pressure among Aboriginal and Torres Strait Islander peoples compared with other Australians.

In the 2004–05 NATSIHS, self-reported rates of high blood pressure were 7% for Aboriginal and Torres Strait Islander peoples. After adjusting for differences in age structure, Indigenous males and females reported having high blood pressure at 1.4 and 1.6 times the rate of non-Indigenous males and females. There was no significant change in self-reported high blood pressure for Aboriginal and Torres Strait Islander peoples between 2001 and 2004–05. For Indigenous Australians, rates started rising at younger ages than for non-Indigenous Australians (25–34 years and over). Rates were higher in remote areas than non-remote areas for both Indigenous males and females. Self-reported data under-estimate prevalence as not everyone who has the condition will have been diagnosed.

An evaluation of adult health checks in one Indigenous health service found that 12% of participants presented with high blood pressure (Spurling et al. 2009). Another study in selected remote communities found rates of high blood pressure that were 3–8 times higher than in the general population (Hoy et al. 2007).

Most cases of high blood pressure are managed by GPs or medical specialists. When hospitalisation occurs it is usually due to cardiovascular complications resulting from chronic blood pressure elevation. During the two years to June 2010, hospitalisation rates for hypertensive disease were 2.9 times as high for Aboriginal and Torres Strait Islander peoples as for other Australians. Among Aboriginal and Torres Strait Islander peoples, hospitalisation rates started rising at younger ages with the greatest difference in the 55–64 year age group. This suggests that high blood pressure is more severe, occurs earlier, and is not controlled as well for Indigenous Australians. As a consequence, severe disease requiring acute care in hospital is more common.

BEACH survey data collected from April 2006 to March 2011 suggest that high blood pressure represented 4% of all problems managed by GPs among Indigenous Australians. After adjusting for differences in the age structure of the two populations, rates for the management of high blood pressure among Indigenous Australians were similar to those for other Australians.Top of page

Implications:

Self-reported prevalence of high blood pressure was 1.5 times as high and hospitalisation rates were 2.9 times as high for Aboriginal and Torres Strait Islander peoples as they were for non-Indigenous Australians, but high blood pressure accounts for a similar proportion of GP consultations for each population. This suggests that Indigenous Australians are less likely to have their high blood pressure diagnosed and less likely to have it well controlled given the similar rate of GP visits and higher rate of hospitalisation due to cardiovascular complications.

Research into the effectiveness of quality improvement programs in Aboriginal and Torres Strait Islander primary health care services has demonstrated that blood pressure control can be improved by a well-coordinated and systematic approach to chronic disease management (e.g., (McDermott et al. 2004). Identification and management of hypertension requires access to primary health care with appropriate systems for the identification of Aboriginal and Torres Strait Islander clients and systemic approaches to health assessments and chronic illness management. Blood pressure is measured by two of the Essential Indicators for the Healthy for Life Program to aid in quality improvement of the incidence and management of chronic disease (see measures 3.04, 3.05 and 3.18).

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (COAG 2008c) comprises various reforms including a focus on preventive health and primary health care. The Commonwealth's contribution to the Agreement, the Indigenous Chronic Disease Package, includes measures that will help to increase the uptake of MBS-funded primary health care services by Aboriginal and Torres Strait Islander peoples. There has been a significant increase in the uptake of MBS-listed adult health assessments since the program commenced in July 2009. Measurement of blood pressure is one of the key elements of an adult health assessment.

The Assessing the Cost-Effectiveness in Prevention (ACE-Prevention) study found that prescribing a polypill (containing a combination of blood pressure and cholesterol lowering drugs as well as aspirin and folate) has the potential to reduce the cardiovascular disease health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians (Vos et al. 2010).Top of page
Table 9—Aboriginal and Torres Strait Islander peoples reporting high blood pressure or hypertension, by sex and remoteness, 2001 and 2004–05
2001 (%)2004-05 (%)
Males remote
7
10
Males non-remote
5
6
Males total
6
7
Females remote
10
10
Females non-remote
7
7
Females total
8
8
Source: ABS & AIHW analysis of 2001 National Health Surveys (Indigenous supplements) and 2004–05 National Aboriginal and Torres Strait Islander Health Survey
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Figure 27—Age-specific hospitalisation rates for hypertensive disease, by Indigenous status and sex, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010
Figure 27—Age-specific hospitalisation rates for hypertensive disease, by Indigenous status and sex, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 28—People reporting high blood pressure, by Indigenous status, sex and age, 2004–05
Males
Figure 28—People reporting high blood pressure, by Indigenous status, sex and age, 2004–05—Males
Females
Figure 28—People reporting high blood pressure, by Indigenous status, sex and age, 2004–05—Females—
Note: total is age-standardised.
Source: ABS & AIHW analysis 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
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